Neglected tropical diseases

WHO Executive Board recommends mycetoma resolution to World Health Assembly

28 January 2016 | Geneva −− The 138th Executive Board of the World Health Organization (WHO) has today recommended a resolution on mycetoma to the 69th World Health Assembly, paving the way for its adoption in May 2016.

© Alan Baring
People who walk barefoot and agricultural labourers and herdsmen are those worst affected

Following extensive debate by Member States the Executive Board has requested that WHO’s Strategic and Technical Advisory Group for Neglected Tropical Diseases presents a paper by May 2016 outlining the criteria for determining what qualifies a disease as a “neglected tropical disease”.

Many Member States have acknowledged that elaborating a public health strategy will require research, including product development, to ensure cost–effective prevention, diagnosis, early treatment and case management practices in low-resource settings.

Mobilizing additional resources will be essential to facilitate the inclusion of public health interventions against mycetoma. Some product development partnerships have begun to provide support to research. For example, the Drugs for Neglected Diseases initiative will test a promising new treatment for eumycetoma as part of its 2015–2023 business plan.

Currently, early diagnosis and treatment with the available tools is the most appropriate approach. Treatment options depend on the causative organisms involved. Bacterial mycetoma (actinomycetoma) requires long-term treatment with a combination of antibiotics, tailored to the type of bacteria involved. Fungal mycetoma requires antifungal medicines and surgery.

Mycetoma was first reported in the modern literature in 1694. The disease is commonly known as “Madura foot” after the description of a case reported in the mid-19th century in the Indian town of Madura. Although it usually affects the foot, other parts of the body such as legs, back, hands, head and neck may also be involved.

The disease

Mycetoma is a chronic, progressively destructive inflammatory disease of the skin, subcutaneous and connective tissue, muscle and bone. It can be caused by a large variety of microorganisms, but has essentially two distinct etiologies: bacterial and fungal.

Infections with bacteria such as Actinomadura madurae, Streptomyces somaliensis and Nocardia brasiliensis cause actinomycetoma, and those with fungi such as Madurella mycetomatis are responsible for eumycetoma. The latter is the most common causative agent of mycetoma worldwide.

The disease usually spreads to involve the skin, deep structures and bone but can also spread to more distant sites through the blood and lymph. If left untreated, the disease leads to destruction, deformity and loss of function, which may be fatal.

Preventing infection is difficult, but people living in or travelling to endemic areas should be advised not to walk barefoot, as footwear and clothing in general can protect against puncture wounds.

Distribution and burden

The global burden of mycetoma cannot be determined accurately as there is a lack of accurate data on its incidence, prevalence and distribution.

A review carried out in 2013 reported a total of 8763 cases from 50 literature studies published since 1956. Most of the cases (75%) were reported from the following countries: Mexico (2607 cases), Sudan (2555 cases) and India (1392 cases).

The disease commonly affects young adults, particularly men aged between 20 and 40 years. Infection is thought to be acquired by traumatic inoculation of fungi or bacteria into the subcutaneous tissue following minor trauma or a penetrating injury.

Poor people who walk barefoot and manual workers, such as agricultural labourers and herdsmen, are those worst affected. Infection is not directly transmitted from person to person and no animal reservoir has been shown to be involved in transmission.